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Disertaciones |
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1
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Sidclei Queiroga de Araujo
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Spatial distribution of psychosocial care centers (CAPS) in the Federal District: referenced primary care and health inequities
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Líder : WALTER MASSA RAMALHO
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MIEMBROS DE LA BANCA :
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EVERTON NUNES DA SILVA
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HELEN DA COSTA GURGEL
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RENATO ANTUNES DOS SANTOS
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WALTER MASSA RAMALHO
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Data: 27-ene-2023
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Resumen Espectáculo
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Objective: To evaluate the distance from CAPS and UBS referenced in the Federal District. Method: This is a descriptive and ecological study, based on the georeferencing of CAPS and UBS, in the DF, identified and extracted from the National Registry of Health Establishments (CNES), in the month of 07/2020, by the address record . Indicators that portray the socioeconomic situation in the different areas of the DF were sought. Results: In the present study, an unequal geographic distribution was identified between the health regions of the DF for the offer of CAPS, especially when observing the profiles of social vulnerability and income for the distance of the UBS with the CAPS in their different modalities of the profile of attendance. This reinforces the theories of the Inverse Care Law and the Inverse Equity Hypothesis, which expresses that the supply of health services and professionals tend to be concentrated in more privileged places and lacking in the most socially vulnerable places, that is, generating more iniquity. Conclusion: This study sheds light on how the network is organized in the territory for this moment of adversity. The power of CAPS, among other mental health services, is related to a proposal to change mental health care to a psychosocial, humanized and territorialized approach, matrixing the teams in the UBS.
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2
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Liziane Pereira de Melo Alves
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ABSENTEÍSMO DECORRENTE DA COVID-19 NOS HOSPITAIS DA REDE EBSERH
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Líder : MAGDA DUARTE DOS ANJOS SCHERER
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MIEMBROS DE LA BANCA :
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MAGDA DUARTE DOS ANJOS SCHERER
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NOEMIA URRUTH LEAO TAVARES
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WALLACE ENRICO BOAVENTURA GONCALVES DOS SANTOS
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FRANCINE LIMA GELBCKE
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Data: 27-ene-2023
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Resumen Espectáculo
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Absenteeism is determined as non-attendance to work for various reasons, among them sick leave is one of the most recurrent that directly impacts the management of human resources and the organization's performance. In the hospital context, the absence of a worker can result in loss of quality of care provided and increase operating costs for the Hospital. In the context of the worker, absence can generate insecurity or even more stressors due to a health problem. Human resources management contributes as one more factor of analysis and solution for the performance of the organization, being important in the knowledge of the factors that indicate a greater propensity to leave, allowing the institution to act in the promotion and prevention of leaves. In view of this, the objective of this study was to analyze the absenteeism related to COVID-19 of health professionals who work in the EBSERH hospital network from February 26, 2020 to July 31, 2020. data from the FORCE II survey that analyzes the direct and indirect impact of COVID-19 on the health workforce of hospitals in the EBSERH network. In this one, we work in a descriptive, transversal way with a quantitative approach, through the analysis of secondary data available from the occupational medicine registration system of the EBSERH network. In order to define the studied population, leaves were defined as of the first case of COVID in Brazil, February 26, 2020, and for uniformity of data analysis, only workers who act as health professionals were defined, according to the resolution of the National Health Council with employment relationship with EBSERH who registered leaves in the determined period for reasons related to COVID, totaling 19,224 records of leaves. A description of sick leaves was carried out through analysis of the frequency index calculated according to the International Occupational Health Commission. First, an overview of leaves in the regions of Brazil was carried out with a description of leaves resulting from COVID-19 and other leaves. The region that had the highest percentage of sick leave due to COVID-19 in the country was the Northeast (65%), even in the face of the larger population of EBSERH workers, the frequency rate (0.90) in the region is about twice that of other regions. The frequency of leave was performed according to personal characteristics and conditions of the employment contract, time of leave from work by workload and by health career. Of the total number of sick leave due to COVID, it was observed that the average number of days off work for these workers was 5.9 (standard deviation: 5.7), with a predominance of leave for women in three regions of the country, Northeast, North and Southeast and male predominance in the Midwest and South regions, the age of 40 to 49 years was among the first or second most frequent in terms of leave due to COVID-19, while for length of service it was observed that the highest rate of leave by COVID-19 occurred among workers who have been with the company for 1 to 3 years in 3 regions of the country (Midwest, Northeast and North) and among workers with a contract for more than 5 years in the Southeast and South regions. With regard to workload, it was observed that direct patient care workers had more than twice the number of leaves in all regions of the country. From the perspective of length of leave, shorter leaves of 1-5 days prevailed in almost all regions of the country. When analyzing the frequency index of leave due to COVID-19 in the health professions, it was not homogeneous, with the careers of Speech Therapist, Physician, Occupational Therapist and Dental Surgeon being among the professions that had the most impact on leave. The results contribute to the understanding of the absences of exposed workers and which occupations were most impacted, providing subsidies for the management of work in the hospitals of the EBSERH.
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3
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Raíssa Monnerat Rumpf
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“Click and fight dengue": The call to action of the Ministry of Health's Instagram campaigns for dengue, zika and chikungunya between 2018 and 2021”
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Líder : ANA VALERIA MACHADO MENDONCA
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MIEMBROS DE LA BANCA :
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ANA VALERIA MACHADO MENDONCA
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FERNANDA VASQUES FERREIRA
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MARIA FATIMA DE SOUSA
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PATRÍCIA MONTEIRO CRUZ MENDES
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Data: 07-jun-2023
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Resumen Espectáculo
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“Brazil faces, annually and cyclically, epidemics of dengue, zika and chikungunya. Despite the constant surveillance and public campaigns to combat the vector of these diseases, the Aedes aegypti mosquito, what is observed is a constant increase in the number of cases in Brazil, year after year. With the COVID-19 pandemic, decreed in Brazil at the beginning of 2020, this situation became even more fragile. As the COVID pandemic spread, the dengue vector followed its life cycle and its breeding peaks, leaving the Brazilian population vulnerable not only to the threat of the coronavirus, but also that of this old acquaintance of tropical climates, the Aedes. But in all these years of fighting this mosquito, have we learned nothing about how to effectively fight it? One of the main pillars for controlling a vector such as Aedes, which represents a public health emergency for the country - in addition to the direct control measures taken by the state, such as inspection - is the pillar of communication. This pillar, more than audiovisual campaigns - formerly broadcast only on open television channels, printed newspapers and pamphlets, and currently inserted and developed for social networks such as Instagram, WhatsApp and TikTok - is also composed of strategies that drive these campaigns aiming to bring them closer to the target audience and make them more accessible, understandable and capable of mobilizing the interlocutor to take an attitude in this given situation. This dissertation makes a temporal cut precisely of the overlap of the COVID-19 pandemic and the dengue, zika and chikungunya epidemics, between the years 2018 and 2021. Thus, the use of the digital marketing tool Call to Action on Instagram was analyzed on the Instagram of the Ministry of Health in the period cited. The research is exploratory with a quali-quantitative approach, fulfilling a theoretical analysis of Ministry's communication in publications focused on dengue, zika and chikungunya. After synthesizing and systematizing this content, two scientific articles were produced. The first with a quantitative focus, evaluated that, in the total of 187 publications analyzed, 168 of these used the CTA tool. This research points out that, despite the large number of published CTAs, their use does not comply with the criteria for creating effective and efficient CTAs. The second article was produced with a qualitative approach, based on the French Discourse Analysis approach, pointing out semantic choices and language connotations present in the CTAs of two campaigns chosen for analysis.”
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4
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Fabiana Mascarenhas Sant'Ana
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“_Information, education and communication as strategies to support decision-making for the prevention of arboviruses: a scoping review _”
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Líder : MARIA FATIMA DE SOUSA
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MIEMBROS DE LA BANCA :
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MARIA FATIMA DE SOUSA
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ANA VALERIA MACHADO MENDONCA
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JORGE OTAVIO MAIA BARRETO
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PATRÍCIA MONTEIRO CRUZ MENDES
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Data: 15-jun-2023
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Resumen Espectáculo
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“___Initiatives to assist the decision-making process in health have been encouraged worldwide. In this context, integrated Information, Education and Communication (IEC) actions demonstrate potential to support management professionals in the development of policies and programs. The current study sought to map IEC strategies to support decision-making in health in prevention and control actions against dengue, zika, and chikungunya. In Brazil, there are still no manuals or guidelines with IEC strategies on arboviruses aimed at managers, and this gap is the main reason for this investigation. This is a scoping review, prepared according to the JBI methodology. Nine databases were consulted, including a manual search of the reference lists of eligible studies. Results: In total, 28 articles were identified. The majority presented associated strategies (n=25), with a predominance of those related to the categories Information, Education and Communication (n=12) and Information and Communication (n=11), followed by Communication and Education and Education and Information, with one article each. Three articles related to the Information category were found. Regarding the format (digital, printed, audiovisual, etc.), Hybrids, which group different formats (n=13) were the most frequent, followed by Digital (n=10), Printed and/or Digital (n=3) and Onsite and/or Virtual (n=2). With regard to the type of arbovirus, strategies focused on dengue control and prevention predominate (n=18). Among those analyzed, only five studies contemplated strategies that encompass more than one arbovirus. Conclusion: The findings reveal that studies that consider strategies aimed exclusively at decision makers (n=9) and that seek to promote the integration of this public are less frequent (n=9). No studies were identified that considered aspects related to the different profiles of management professionals for the elaboration of strategies. It is hoped that this work can collaborate to guide the IEC strategies adopted by different institutions and governments in the control of arboviruses._”
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5
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LUAN DIEGO MARQUES TEIXEIRA
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“ BARRIERS AND POTENTIALS FOR MEDICAL TRAINING IN MENTAL HEALTH IN PRIMARY CARE ”
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Líder : DAIS GONCALVES ROCHA
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MIEMBROS DE LA BANCA :
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DAIS GONCALVES ROCHA
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DIRCE BELLEZI GUILHEM
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Elisangela Teixeira Gomes Dias
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MARCELO KIMATI DIAS
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Data: 29-jun-2023
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Resumen Espectáculo
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“ The care for mental health in primary care is essential for the inclusion and noninstitutionalization of the patient, as well as for the development of the field itself. However, the lack of training among medical professionals is one of the main obstacles to providing this type of care. In this context, this study aimed to analyze the barriers and facilitators present in the published scientific literature regarding the implementation of educational interventions for primary care physicians in the care of mental health patients. We conducted a scoping review following the principles of the Joanna Briggs Institute (JBI). The central question of this study was: "What are the scientific evidence related to the training of primary care physicians in the care of patients with mental health needs?" To answer this question, we searched articles in electronic databases such as PubMed, MEDLINE, Lilacs, SciELO, Embase, Scopus, BDTD, and Google Scholar, using the keywords: "physicians" OR "General Practitioners" AND ("medical education" AND "mental health") AND "Primary Health Care" OR "Primary Health". This search strategy, applied specifically to each of the seven databases and considering publications between 2012 and 2022, resulted in 4,117 articles. These articles were then imported into the Rayyan QCRI software, and duplicates were eliminated. In addition to duplicates, we excluded works that were case reports, editorials, letters, and conference abstracts. Using this software, two independent reviewers examined the titles and abstracts of 3,375 articles, selecting 256 for full reading. Of these readings, only 76 articles effectively answered the research question. These studies used a variety of methodologies, mainly including randomized clinical trials and qualitative interviews. The main findings indicated interventions aimed at improving the identification of mental illnesses, supporting family physicians, and implementing therapeutic strategies. The analysis of the literature from the last ten years highlighted the predominance of publications on systemic, structural, and professional barriers to physicians' training. Among these, geographical limitations, lack of time for training, and physicians' motivation stood out. However, among the facilitators, online training offerings, stigma reduction-focused training, and prior professional education were highlighted. ”
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6
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EDUARDO FERNANDO HORTÊNCIO CLEMENTE
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“____LEVEL OF PHYSICAL ACTIVITIES OF UNIVERSITY STUDENTS: ANALYSIS OF THE PROPOSAL AND PROMOTION OF THE PRACTICE OF LEISURE PHYSICAL ACTIVITY WITHIN THE UNIVERSITY OF BRASÍLIA ____”
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Líder : MIGUEL ANGELO MONTAGNER
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MIEMBROS DE LA BANCA :
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MIGUEL ANGELO MONTAGNER
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MARIA INEZ MONTAGNER
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Marcelo Moreira Corgozinho
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SANDRA MARA CAMPOS ALVES
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Data: 30-jun-2023
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Resumen Espectáculo
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“_Sedentarism affects approximately half of the Brazilian population, being associated with more than 10% of deaths in Brazil. The university routine can both limit and promote the practice of Leisure Physical Activities (LPA) by the academic community. On the one hand, university games, disciplines of sports practices and university extension projects can encourage the practice of AFL. On the other hand, the routine of university students tends to present limitations in the availability of time to practice LPA. The objective of this study is to analyze the promotion of AFL proposed by the University of Brasília (UnB). The cross-sectional study was based on data collection through the international physical activity questionnaire and focus groups with undergraduate university students from UnB, in addition to semi-structured interviews with those responsible for actions to promote the practice of LPA within UnB. The study indicated concern about the approximately 17% who were diagnosed as sedentary or irregularly active. Within this panorama, common factors were identified to be considered priorities in future projects to combat academic sedentary lifestyle: university students working at night and of the female gender. Of particular note were the Social Development Directorate's projects to combat sedentary lifestyles, thus improving the quality of life of low-income or socially vulnerable university students, with only 2% of sedentary university students considered low-income or socially vulnerable. Volleyball, futsal, soccer and table tennis were identified as the most practiced leisure physical activities among university students and Athletics as the institution that most promotes the practice within the institution. There is isolation from the other campuses in the context of promoting the AFL, the Darcy Ribeiro campus is the campus with the best infrastructure for the practice of AFL and where the main projects and programs for the practice of AFL are concentrated.___”
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7
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VICTOR FONSECA VIEIRA
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“The transgender ambulatory of Brasília: trajectory, policies and experiences”
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Líder : XIMENA PAMELA CLAUDIA DIAZ BERMUDEZ
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MIEMBROS DE LA BANCA :
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MARÍA SOLEDAD CUTULI
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EDGAR MERCHAN HAMANN
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LUCELIA LUIZ PEREIRA
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XIMENA PAMELA CLAUDIA DIAZ BERMUDEZ
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Data: 26-jul-2023
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Resumen Espectáculo
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“Introduction: The Transexualizer process policy from the Brazilian Unified Health System (SUS) was born in 2018 and redefined in 2013, with the aim of standardizing specialized healthcare services for trans people. In the Federal District, the specialized service first occurred in 2017, with the status of reference for this population in the Brazilian capital. The literature points out that this population still faces essential assistance gaps in terms of accessing healthcare services, caused by consequences of discrimination, prejudice against identity, disrespect to social names and lack of professional qualification. Objectives: This study analyzes the trajectory of the Transgender Ambulatory of Brasília, describes important political and programmatic framework during this path; the experiences undergone by health workers and trans people assisted by this service, and identifies assistance, administrative and political gaps found since its implementation. Method: Qualitative-analysis study carried out through the execution of 30 semi structured interviews applied to health professionals, managers and trans people at the ambulatory headquarters. After transcription of the interviews, the analytical categories that emerged from the narratives were processed and classified with the aid of the the Imurateq software. Results: It is worth noting that the transgender individuals interviewed consider that their identities are respected in these places, opposed to what happens in other healthcare providers from the Public Healthcare Network. It was identified that there are breaches that fragilize these services concerning the political-programmatic, administrative and assistance routes. One of the main challenges indicated by the users of the Transsexualizer Process is the access to hormone therapies. The conduction of surgeries of adequation to the biological body and gender identities were also pointed as a fundamental assistance gap. Conclusion: Despite the guarantees assured by the Unified Health System to implement one policy of integral assistance to the transgender people, there are yet barriers for the Trans Ambulatory of Brasília to overcome in order to make the politics effective, due mainly to institutionalization of its actions and lack of insertion of this service into the organogram of the Department of Health of the Federal District. This fact entails an institutional void that emerges as an important political-programmatic gap and impacts its possibilities of action. There are also observed weaknesses in the sense of financial resources allocation and the construction of a multiprofessional framework of human resources capable of doing the full exercise of political actions, in addition to the establishment of adequate physical space. By constituting the only specialized service in the FD, it results in overcrowding which generates an undesired waiting list limiting user access. The trans individuals interviewed characterize the site/service as cozy and safe for them to fully perform their identities. ”
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8
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Camilla de Miranda Ribeiro
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“CHARACTERIZATION OF PNEUMOCOCCAL MENINGITIS CASES AND DEATHS AND IMPACT OF THE 10-VALENT PNEUMOCOCCAL CONJUGATE VACCINE IN BRAZIL, 2007 TO 2019.”
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Líder : EDGAR MERCHAN HAMANN
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MIEMBROS DE LA BANCA :
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CAMILE DE MORAES
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EDGAR MERCHAN HAMANN
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ELISABETH CARMEN DUARTE
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HENRY MAIA PEIXOTO
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Data: 10-oct-2023
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Resumen Espectáculo
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“Introduction: To characterize the epidemiological profile of cases of Pneumococcal Meningitis (PM) in the pre- and post-implantation periods of the 10-valent pneumococcal vaccine (Conjugate) (PCV-10) in Brazil. Methods: A descriptive study of PM cases registered in the Notifiable Diseases Information System (Sinan) between 2007-2019 was carried out. The year 2010 (year of introduction of PCV-10) was excluded. The following periods were defined: pre-vaccination (2007-2019) and post-vaccination (2011 to 2013), (2014 to 2016) (2017 to 2019). Results: In Brazil, there were 12,105 cases of PM between 2007-2009 (n=3,158; 26.1%), 2011-2013 (n= 3,246; 26.8%), 2014-2016 (n= 2,709; 22.4 %) and 2017-2019 (n= 2,992;24.7%). There was a predominance of males in the analyzed period. There was a reduction in cases in children < 01 year of age, in the three post-vaccine three-year periods (11.5%, 10.6% and 8.2%, respectively). In the age group ≥ 60 years old, the proportion of cases corresponded to 9.4% before vaccination. In the three post-vaccination periods, it corresponded to 13.4%, 16.4% and 19.7%, respectively. In these age groups, similar changes were observed in relation to deaths. The lethality rate was approximately 29.0%, even after the introduction of the vaccine. In the pre- and post-vaccination period, there were cases in the 27 Federative Units (FU), concentrated in the Southeast (60.9%), and in this region there was an increase in the average number of cases in the three post-vaccination periods (n =1,870) in relation to the pre-vaccination period (n=1,764). Conclusion: There were changes in the age group distribution after the use of PCV-10 and a slight increase in cases in the Southeast, suggesting that vaccine coverage and serotypes not included in the vaccine may be associated with this fact.”
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9
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Aline Oliveira Cardoso
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“__"Men hurt us too much": the experience of women in situations of domestic violence and the role of Primary Health Care________”
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Líder : MIGUEL ANGELO MONTAGNER
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MIEMBROS DE LA BANCA :
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MIGUEL ANGELO MONTAGNER
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PEDRO DE ANDRADE CALIL JABUR
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SANDRA MARA CAMPOS ALVES
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XIMENA PAMELA CLAUDIA DIAZ BERMUDEZ
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Data: 13-dic-2023
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Resumen Espectáculo
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“_Domestic violence is a phenomenon intersected by different social markers, representing a reality in the Federal District, affecting the lives of thousands of women. Simultaneously, as a public health issue, primary care professionals must play a crucial role in supporting these women through their outpatient services. This research aims to comprehend and analyze manifestations of violence against women residing in the Rural Nucleus Lago Oeste in the Federal District and to explore the perception and conduct of health professionals at the UBS in the adjacent region when it comes to providing care for women experiencing domestic violence. This is a qualitative study, using the techniques of participant observation and semi-structured interviews with women victims of violence and the health professionals at the UBS they are users. Through the analysis of interviews using the collective biography method, a common panorama emerged depicting how these women experienced instances of violence and how some managed to break free from these cycles. The results of interviews with health professionals demonstrated empathy and actions oriented towards care, but at the same time, acknowledgment of the lack of training for better serving these women. In the discussion, we categorized the themes by the typology of violence, according to the Maria da Penha Law, comparing the accounts of women and professionals with the provisions of this law and the National Policy to Confront Violence Against Women. We consider that the violence confrontation network has various gaps, inadequacies, and a lack of professional training, along with a deficiency in communication between multidisciplinary sectors and individualized support for each woman in a situation of violence. _
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10
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Carina Leão de Matos
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“_SELF-HARM VIOLENCE IN ADOLESCENTS AND YOUNG ADULTS OCCURRING IN THE FEDERAL DISTRICT FROM 2017 TO 2021__”
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Líder : IVAN RICARDO ZIMMERMANN
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MIEMBROS DE LA BANCA :
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GLAUCIA TALITA POSSOLLI
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IVAN RICARDO ZIMMERMANN
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MARCUS TOLENTINO SILVA
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VIVIAN SIQUEIRA SANTOS GONCALVES
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Data: 13-dic-2023
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Resumen Espectáculo
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“__The concern with the mental health of youth and adolescents has been the subject of discussion worldwide, as we observe an alarming increase in the rates of suicide attempts in this population group. The Federal District (DF) is no exception, showing an increase in these attempts between 2017 and 2021. The objective of this article is to analyze the lethality by self-harm violence in residents of the DF, aged 10 to 24 years, between 2017 and 2021. This is a descriptive and retrospective study of quantitative approach, of ecological type, with use of secondary data of cases of attempted self-extermination (TAE) and deaths by suicide. The result of this analysis showed that, despite the increase in the cases of TAE, in this same period there was a decrease in the lethality of these acts. However, one must consider the overall burden of suicide and its attempts on the young population and the importance of this for public health_”
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11
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Sara da Silva Meneses
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“____Biomedical capitalism and its repercussions on interprofessional health work _______”
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Líder : DAIS GONCALVES ROCHA
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MIEMBROS DE LA BANCA :
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DAIS GONCALVES ROCHA
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CLAUDIO FORTES GARCIA LORENZO
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DIRCE BELLEZI GUILHEM
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MARINA PEDUZZI
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Data: 15-dic-2023
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Resumen Espectáculo
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“_The goal of this study was to understand the relationship between capitalism/biomedical model and the barriers and facilitators for the interprofessional work of multidisciplinary teams in primary health care, in the scientific literature published in Brazil and internationally. The theoretical framework was based on the interpretative paradigm with a critical focus from the theoretical lens of the social determination of health. A scoping review was developed that mapped the barriers and facilitators for interprofessional work in primary health care with a methodology based on the Joanna Briggs Institute (JBI). Six databases and repositories were searched: VHL (Virtual Health Library); SCIELO (Online Scientific Electronic Library); PUBMED/MEDLINE; LILACS (Latin American and Caribbean Literature in Health Sciences), Web of Science and SCOPUS. 169 mostly qualitative articles were included, published in Portuguese, English and Spanish, with emphasis on production from Canada (50) and Brazil (44). The barriers predominated in relation to facilitators, where biomedical capitalism was evident, which appeared in four dimensions: system – training in the biomedical model; organizational – productivist management and attention; interindividual – hierarchy and concentration of power in medicine; and individual – individualism. The ambience and creativity in the organization of workflows were identified as innovative facilitators in the theme. The methodology for evaluating interprofessional work is still mostly qualitative and the review indicates the need to increase the theoretical-methodological foundation of studies on the subject. Disciplines to promote interprofessional work need to take into account the implications of biomedical capitalism and intersectionality in healthcare. The final chapter of the dissertation presented a discussion of barriers and facilitators from the perspective of the health systems of the countries that appeared most in the scoping review: Canada, Brazil, the United States and the United Kingdom. One of the innovative contributions of this study was in the development of the implication of the capitalist system from the perspective of biomedical capitalism/biomedical model, as a mediator of interprofessional work, expressing itself through various barriers from training, management, care and within the scope of micro level of health professionals, with individualismo.__”
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12
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Suzana de Santana Martins
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“ANALYSIS OF DEATHS RELATED TO FALL ACCIDENTS AMONG ELDERLY PEOPLE IN BRAZIL IN 2021”
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Líder : IVAN RICARDO ZIMMERMANN
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MIEMBROS DE LA BANCA :
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IVAN RICARDO ZIMMERMANN
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KEITTY REGINA CORDEIRO DE ANDRADE
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MARCUS TOLENTINO SILVA
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NOEMIA URRUTH LEAO TAVARES
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Data: 19-dic-2023
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Resumen Espectáculo
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“The study aimed to characterize the profile of mortality related to fall accidents among elderly people, in 2021, in Brazil. This is an observational, retrospective, descriptive study based on secondary data. The analysis included deaths of people aged 60 or over, throughout Brazil, registered in the Mortality Information System (SIM), codes from the International Statistical Classification of Diseases and Related Health Problems (ICD-10) related to falls (W01 to W19). The variables collected were: sex, age, race/color, education, marital status, occupation, administrative region and place of death. On an individual basis, descriptive statistical analyzes were carried out and, in aggregate form, the age-standardized mortality rate due to falls among the elderly in Brazil was calculated. The variables collected were: sex, age, race/color, education, marital status, occupation, administrative region and place of death. On an individual basis, descriptive statistical analyzes were carried out and, in aggregate, the age-standardized mortality rate due to falls among elderly people in Brazil was calculated in the year 2021. Data extraction, manipulation and analysis were carried out using the R language. In 2021, 11,603 deaths due to falls were recorded among elderly people in Brazil. The frequency of deaths due to falls among females was 51.66% and 58.30% in those aged 80 or over; death was higher among those self-declared to be white (62.63%), those with 4 to 7 years of schooling completed (24.55%) and those without a partner (59.6%). In relation to occupation, retired or pensioner (35.44%) and housewife (16.47%) represented more than 50% of deaths. The most common place of death was one's own home (38.04%). In Brazil, the crude mortality rate due to falls among elderly people was 37.03 deaths per 100,000 inhabitants. The age-standardized mortality rate due to falls was highest in the Central-West region (54.85), followed by the South (48.22), Southeast (32.88), North (31.17) and Northeast (27.06). Knowing the profile of deaths due to falls can help guide health guidelines and policies aimed at preventing health problems and promoting health among the elderly population.” U
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Tesis |
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1
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Carlos Mabutana
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“_REIVENTING THE BODY AND TRADITION IN THE PRACTICE OF MALE CIRCUMCISION: A STUDY ON VAMAKONDE IN SOUTHERN MOZAMBIQUE"
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Líder : XIMENA PAMELA CLAUDIA DIAZ BERMUDEZ
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MIEMBROS DE LA BANCA :
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XIMENA PAMELA CLAUDIA DIAZ BERMUDEZ
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ALEJANDRO GOLDBERG
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CRISTIANO GUEDES DE SOUZA
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GERSON FERNANDO MENDES PEREIRA
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MARIA HELENA ORTOLAN
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Data: 15-feb-2023
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Resumen Espectáculo
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“_Introduction: Ritual circumcision, a traditional practice in Mozambique, is present among the different ethnic and religious groups of the country. It is part of the rituals of ethnic rites of passage and itis performed by masters according to cultural beliefs. Male circumcision has been shown to be effective in HIV-transmission prevention in studies conducted in Kenya, Uganda and South Africa. It reduces HIV infection by 38% to 66% in heterosexual relationships and it is recommended by WHO for countries with a high incidence of the infection. However, it is parallel to the traditional practices that must be studied and improved by their various actors to provide choices based on cost/benefit and cost/effectiveness. Objectives: To analyze the introduction of biomedical technology in traditional circumcision among Makonde people, so that it offers safety and health care to the initiates, avoiding the occurrence of adverse events and infections. Method: This isqualitative research with an ethnographic approach, which used empirical experience, anchored to the theories and concepts discussed by some authors such as Van Gennep (1909), Menédez (1994) and others. It also included participatory observation and recorddocumentation through photographic image, voice recording and field notebook notes. Results: the research provided the opportunity to learn from the ability to negotiate the researcher participation in the rituals. It produced a synthesis of evidence showing that it is possible and feasible for actors from initiatory traditions and medical practices to dialogue and perform traditional circumcision, observing medical practices that minimize risks to health. Changes made in traditional surgicalpractice,didnot alter the symbolic meaning nor distort the objectives that guide the Makonde in their rituals. Conclusions: By means of contextualized information on cultural and historical framework of the circumcision practice in contemporary Mozambique, empiric data discloses the need for intermediation and for a continuous and fruitful dialogue between the actors and decision makers of health policies. Both parts should understand their respective activities and objectives understandings that they are not antagonistic. They are valuable elements of the social and cultural community health system. In this case, current scientific evidence in both should be useful in the search for effectiveness in health promotion, prevention and care.
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2
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Celmário Castro Brandão
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FEDERAL GOVERNANCE IN THE MANAGEMENT OF PRIMARY HEALTH CARE TO COMBAT THE COVID-19 IN BRAZIL
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Líder : ANA VALERIA MACHADO MENDONCA
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MIEMBROS DE LA BANCA :
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ANA VALERIA MACHADO MENDONCA
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EVERTON LUIS PEREIRA
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ADEMAR ARTHUR CHIORO DOS REIS
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Andre Luis Bonifacio de Carvalho
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ISABELA CARDOSO DE MATOS PINTO
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Data: 17-feb-2023
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Resumen Espectáculo
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The objective of the present study is to understand the governance of the Ministry of Health (MH) in the management of primary health care (PHC) to face the covid-19 pandemic and its systemic implications in the health care of the brazilian population in the period. This is a study with a qualitative and quantitative approach, subdivided into three stages. In the first one, through exploratory documentary research, a contextualization was carried out about the work of the MH, in its relationship with the Presidency of the Republic (PR), in facing the pandemic in Brazil. In the second stage, the process of agreeing on the policy to deal with the pandemic within the scope of the PHC, by the MH, was approached, also through documentary research. In the third stage, documentary research and the study of data about the production of actions by the teams working in the PHC were carried out, to analyze the response of the services to the propositions made by the MH, taking into account the governance model in the ministry for the formulation and implementation process of such policies. Measures strongly orchestrated by the PR that negatively influenced its performance in coping with the pandemic were evidenced in the MH: turnover of ministers, weakening of the PHC, ineffectiveness in the collapse of the care network, rupture of the federative pact, slowness in the acquisition of vaccines, disregard for science, weakening of the testing strategy, militarization of health, opacity of health information, corruption, lack of coordination of politics, among others. The debate on combat the pandemic in PHC was identified in 23 official meetings, mostly within the scope of management, with scientific spaces and popular participation being reduced. With regard to the content of the 34 ministerial publications, only 15 had been previously discussed with other institutional representations. Finally, the teams'production data allowed an analysis of the PHC's response to the MH's propositions, legitimizing or not it as coordinator of the Unified Health System (UHS) governance network. It was noted that, in most situations, the ordinances published by the MH did not produce any increase in the teams'production in the listed variables. Also, taking into account that more than R$1.7 billion were contributed by the ordinances, a substantial increase in production was expected. However, it is believed that the stance of the MH and the PR led to a deterioration in governance to the point where the legitimacy of the MH in conducting the policy to combat the pandemic in PHC was eroded. It is concluded that the evident central lack of coordination, rupture of the federative pact and hierarchization of the historical model of governance in networks in the UHS, induced in the MH by the authoritarian and denialist agenda of the PR, culminated in harmful consequences for the performance of the country as a whole in facing the pandemic. The main outcome of this action can be summarized in the sad statistics of cases and deaths from covid-19 unevenly distributed in the country, reinforcing the idea that there is an ongoing necropolitics in Brazil.
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3
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Maína Ribeiro Pereira Castro
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“_Digital commensality: the human relationship with food mediated by communication technologies”
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Líder : ANA VALERIA MACHADO MENDONCA
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MIEMBROS DE LA BANCA :
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ANA VALERIA MACHADO MENDONCA
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EVERTON LUIS PEREIRA
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GIOVANNA MEDEIROS RATAICHESCK FIATES
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MARIA FATIMA DE SOUSA
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MARIELLA SILVA DE OLIVEIRA COSTA
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Data: 26-abr-2023
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Resumen Espectáculo
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“_The act of sharing a meal with other people is known in the literature as commensality. There are a variety of ways of eating together that can be characterized in cultures around the world: from everyday situations to festive situations, in the family context and in other social relationships, at the table and also in other spaces, among others. From the virtualization of society in the contemporary era, other ways of sharing meals are beginning to be perceived, influenced by the presence of technologies before, during and after meals. With the aim of understanding how human relationships with food, when mediated by communication technologies, configure commensality in contemporary society, this thesis proposes to investigate this phenomenon through two studies. The first was a scope review that characterized the main scientific findings related to digital forms of commensality in the 21st century and identified possible relationships between commensality practices and collective health. 104 publications were selected that related commensality and technology in all contexts. Most studies used qualitative methodology; they were from the area of Design and Technology; used social media and video platforms or augmented reality prototypes/devices; and they referred to digital forms of commensality using different terms, which allowed a temporal analysis of the proposition of definitions of the studied phenomenon. With regard to issues related to collective health, the related studies pointed to the following subjects: family/community engagement, development of culinary skills, mental health and eating habits. The second study developed was a netnography carried out with a virtual community on Facebook composed of women who share on the table set in which we sought to describe and analyze the forms of commensality practiced by them either in person or virtually and their relationship with health. Through participant observation, interviews and field notes, it was identified that the community relates by sharing photos of the tables set and decorated for meals held at home, mainly for the family. Although they like to register their tables, the act of photographing them usually occurs before meals, since the use of mobile devices while sharing a meal is considered by them as a violation of good table manners. The practice of setting the table was recognized as an act of hospitality and an incentive to traditional eating, strengthening human relationships through shared food. It is noteworthy that in the context of the COVID-19 pandemic, in addition to sharing photos of the tables set, women reported practicing other digital forms of commensality and recognized the importance of the community for their mental health during the period of isolation. The frequency of thematic tables related to awareness months for the prevention of certain diseases, such as yellow September, pink October, blue November, proved to be a powerful strategy for communication in health at home, making these women multipliers of campaigns. In conclusion, this thesis reveals the variety of ways in which commensality has been practiced and investigated in contemporary society with regard to technological mediation, pointing out the importance of this phenomenon for the configuration of human relationships around eating. In addition, it raises the debate of relating such practices to collective health. ”
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4
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Melina Mafra Toledo
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"COLLECTIVE DISCOURSE: KNOWLEDGE, ATTITUDES AND PRACTICES IN FRONT OF LATENT TUBERCULOSIS INFECTION (LTBI) AND TREATMENT WITH ISONIAZID 300 MG"
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Líder : WILDO NAVEGANTES DE ARAUJO
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MIEMBROS DE LA BANCA :
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ROSANGELA ELAINE MINEO BIAGOLINI
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MYRIA RIBEIRO DA SILVA
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EVERTON NUNES DA SILVA
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NOEMIA URRUTH LEAO TAVARES
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WILDO NAVEGANTES DE ARAUJO
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Data: 29-may-2023
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Resumen Espectáculo
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“To reduce the dissemination of active tuberculosis (TB) and eliminate the infection worldwide, individuals with Latent Tuberculosis Infection (LTBI) and their contacts must be treated appropriately. Isoniazid (INH) is one of the most consistently recommended alternative regimens in the preventive treatment of LTBI. Most losses in the TB and LTBI treatment process occur in the first steps: contact identification and referral for investigation, which compromises the care cascade. Objective: to understand the thinking and collective action of health professionals regarding LTBI and the use of INH to treat the disease. Method: a quali-quantitative study approach developed in two stages: collective interview with health workers (N=22) divided into three groups: primary care, specialized care and managers of four units of the federation and the Federal District. Data collection took place in Brasília in March 2019. The emerging contents of the groups were analyzed using the Collective Subject Discourse (DSC) technique, which expresses the thinking of a group. or collectivity. The second stage involved a national cross-sectional study on knowledge, attitudes and practices (KAP) with a representative sample (N=56) of health professionals prescribing medication and working in TB care. Results: the professionals speeches revealed uncertainties related to the prevention and treatment of LTBI, the “fear of making mistakes”; and inappropriate ways of using INH 300 mg, the importance of decision-making in the treatment of LTBI, the difficulties and weaknesses in the integration of basic and specialized services, and the absence of care flows/lines of care. On one hand, most participants showed knowledge, attitudes and prevention practices that are consistent with national recommendations for treatment; on the other hand, some of them were uncertain about the knowledge and prevention practices associated with the differences between active TB and LTBI, a key issue for the cascade of care. Conclusion: although the professionals´s; speech emphasizes objective aspects in the management of LTBI, the subjective expressions of the fears affecting the decisions over the treatment are important and must be considered in the management and planning of health actions, in order to think about this process in a collaborative and autonomous way, both for professionals and for the person with LTBI. Thus, the findings of the study suggest that future actions for the prevention and control of tuberculosis should prioritize interventions aimed at knowledge, attitudes and practices about LTBI, as well as the reduction of problems in infrastructure, which certainly go beyond the operational limits in health care, and relate to the social determinants of health.”
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5
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Ana Cláudia Cardozo Chaves
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"Mechanisms that influence Primary Health Care effectiveness"
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Líder : MAGDA DUARTE DOS ANJOS SCHERER
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MIEMBROS DE LA BANCA :
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LIGIA GIOVANELLA
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PATRÍCIA SAMPAIO CHUEIRI
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LEILA BERNARDA DONATO GOTTEMS
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MAGDA DUARTE DOS ANJOS SCHERER
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NOEMIA URRUTH LEAO TAVARES
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Data: 31-jul-2023
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Resumen Espectáculo
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At Primary Health Care (PHC), a proposal to reorient services making them more effective, achieving effectiveness is a challenge. In many realities, there are gaps between what individuals and communities need, and services quality, leaving many users without access or excluded from standardized actions for specific conditions, with low effectiveness leading even to the chronification of acute events. The present work aims to understand the mechanisms that influence PHC effectiveness, from conceptions, critical elements and agents with potential influence for its development. This is a single integrated case study, with exploratory and analytical character, qualitative approach, whose unit of analysis is PHC effectiveness in Brazil’s Federal District (FD), based on the evaluative activities of the Qualification Program of Primary Health Care (QualisAPS). A triangulation of documentary research and focus groups techniques were used for data collection, in which participants were managers or supervisors of PHC, and health professionals of the higher and middle levels from FD Family Health Strategy, totaling 245 participants. The results came from 10 documents and 22 focus groups conducted in 2020 and 2022. The software ATLAS.ti version 9.0 was used for systematization and data analysis according to effectiveness, PHC and multilevel governance theoretical frameworks, and Ergology theoretical-methodological framework. It is possible to conceive effectiveness in PHC from several approaches, more or less comprehensive, incurring risks of relativism and reductionism. There is confusion between the concepts of effectiveness and quality in health, as well as effectiveness and response capacity. Several attributes, capacities and expected results were considered critical elements, as well as the complex nature of health problems and structuring conditions for PHC proper functioning, aspects already recognized in the literature. None of these critical elements are exclusive to effectiveness and its use as an analytical or evaluative category of PHC is questionable. In addition, effectiveness in PHC falls massively as a charge on health professionals and frontline managers, agents of the micro level, when it should be understood as a shared responsibility by a multilevel governance network, involving several agents from brazilian Unified Health System, directly or indirectly. The more macro is the level of the agent in this network, lower isthe clarity about their responsibilities for an effective PHC, but their influence is present anyway, either in omissions or worsening flows, impairing resolvability. By not recognizing this network, we distance ourselves from implementing an effective PHC in solving health problems. In the FD, predominates the perception of PHC low effectiveness. To mitigate the conceptual limitationsidentified and better instrumentalize the search for results, it isrecommended to review the use of the word resolvability in technical documents, which can be used as jargon, but should be replaced to guide clearer and more strategic guidelines by the concepts of effectiveness and response capacity
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6
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Pâmela Cristina Gaspar
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“__Sexually transmitted infections that cause urethral discharge in men: etiological approach as a strategy of public health policy in Brazil ”
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Líder : ADELE SCHWARTZ BENZAKEN
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MIEMBROS DE LA BANCA :
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MAURO CUNHA RAMOS
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ADELE SCHWARTZ BENZAKEN
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ANGELICA ESPINOSA BARBOSA MIRANDA
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EDGAR MERCHAN HAMANN
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MARA CRISTINA SCHEFFER
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Data: 25-ago-2023
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Resumen Espectáculo
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“Male urethral discharge is characterized as one of the symptoms of urethral inflammation, also known as urethritis. When caused by Sexually Transmitted Infections (STIs), urethritis is classically divided into gonococcal, caused by Neisseria gonorrhoeae, and non-gonococcal. The main etiological agents of non-gonococcal urethritis are Chlamydia trachomatis, Mycoplasma genitalium, Ureaplasma urealyticum, and Trichomonas vaginalis. The syndromic approach involves using clinical algorithms to identify groups of easily recognized signs and symptoms that characterize a syndrome and initiating treatment according to the syndrome. Despite being a very useful and necessary practice in the past, the World Health Organization (WHO) has been discouraging its use due to a series of limitations. Therefore, the replacement of the syndromic approach with the etiological approach, which involves identifying the causative pathogen of the infection through testing and managing the case accordingly, is urgently needed worldwide. The objective of this study was to analyze scenarios, actors, and components aiming to incorporate the etiological approach as a strategy of public health policy in Brazil for the clinical management of sexually transmitted infections causing urethral discharge in men within the scope of the Unified Health System (SUS). It is a descriptive-exploratory study using a qualitative and quantitative approach supported by method triangulation. Thus, the study included the analysis of the quality of the national protocol for the management of male urethral discharge using the AgreeII instrument; analysis of secondary data from questionnaires answered by management professionals and laboratories participating in the pilot network for the molecular detection of Chlamydia trachomatis and Neisseria gonorrhoeae in the SUS and their perception of the process; determination of the detection rate of CT and/or NG infection among patients tested in the pilot network, as well as the analysis of factors associated with the presence of CT and/or NG infection in this population. Finally, semi-structured interviews were conducted with professionals from state management of STIs, laboratories, and healthcare providers (doctors or nurses), aiming to systematize, from the perspective of these professionals, the notion of the problem, challenges, and strengths related to the implementation of the etiological approach. The analysis of the national protocol highlighted important points for modification, particularly regarding the algorithm of diagnosis, and treatment, which require changes based on gonococcal resistance data in the country and WHO recommendations. The results of the pilot implementation of molecular biology tests for CT/NG detection within the SUS emphasized the importance of making testing available, especially for populations most vulnerable to STIs, while considering the weaknesses and strengths identified in the pilot network. Lastly, the qualitative analysis of the interviews revealed the need for national data availability on non-notifiable STIs and raising awareness among management professionals about implementing the etiological approach for the management of urethral discharge. Workflow change, the culture of the syndromic approach, and the unavailability of rapid diagnostic tests are weaknesses mentioned by clinical professionals, who showed more awareness than management professionals. Finally, the statements of laboratory experts highlight the need for more advanced technologies, especially for surveillance purposes. At the same time, they consider decentralization of testing for healthcare assistance crucial for expanding access to diagnosis and guiding clinical management based on results. In conclusion, Brazil has made progress in strategies and actions for implementing the etiological approach for managing urethral discharge in men. However, the results of this study suggest the need for changes and strategic actions to ensure successful implementation within the scope of the SUS.”
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7
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ELIZABETH ALVES DE JESUS PRADO
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“CAPABILITIES IN THE PREVENTION OF DENGUE, ZIKA, AND CHIKUNGUNYA ARBOVIRUSES: CONTEXTS, REALITIES, AND CHALLENGES”
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Líder : MARIA FATIMA DE SOUSA
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MIEMBROS DE LA BANCA :
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ANDREIA MARIA ARAUJO DRUMMOND
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CARLA TARGINO DA SILVA BRUNO
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DAIS GONCALVES ROCHA
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DANIELA SAVI GEREMIA
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MARIA FATIMA DE SOUSA
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Data: 06-sep-2023
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Resumen Espectáculo
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“ The study of prevention and control of arboviruses in Brazil consists of a complex investigation. Although there are government initiatives, efforts from healthcare professionals, educators, and even the community, the occurrence of Dengue, Zika, and Chikungunya infections has not been overcome in Brazil. Therefore, this research aims to understand the foundational dimensions of health capabilities carried out in primary care for the control of arboviruses Dengue, Zika, and Chikungunya (DZC) in Brazil. To achieve this, a sequential exploratory mixed-methods study is conducted. Through a scoping review on the topic of capabilities, the study presents the concepts of capacity and capability within the scope of healthcare systems, as well as the dimensions of these capacities in the international scientific scenario. Additionally, a qualitative research was conducted using the technique of focus groups, with the purpose of investigating the perception of SUS (Unified Health System) users regarding communication for arbovirus control. Interviews were also conducted with healthcare professionals and endemic disease combatants, analyzing their perception of the capacities for arbovirus control. Through questionnaires, the perception of Brazilian managers regarding the capacities for arbovirus control and prevention was investigated quantitatively.This is a nationwide study conducted in the five regions of Brazil, as an integral part of a national multicenter research project carried out between 2016 and 2022. The results highlighted four dimensions of health capabilities, which involve logistical, normative, financial, and human capacities, considered essential for fulfilling the core functions of public health in healthcare systems. Regarding Dengue, Zika, and Chikungunya arboviruses, the results showed the incipient nature of communication capabilities in media campaigns, as well as the need for greater improvement and investment in control and prevention actions for these arboviruses. Investment in research, human resources, and technological innovation were also prominent in this study. Finally, it is recommended to develop a communication plan that involves the population in its formulation, combining different means of translation and dissemination of knowledge obtained from available evidence, along with community, small group, and individual activities, fostering a sense of belonging and consequently promoting a heightened awareness of health consciousness..”
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8
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ANA PAULA BORGES CARRIJO
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“THE CLINICAL COMMUNICATION OF WOMEN'S SEXUALITY IN THE SCOPE OF PRIMARY HEALTH CARE”
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Líder : XIMENA PAMELA CLAUDIA DIAZ BERMUDEZ
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MIEMBROS DE LA BANCA :
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LUIZ FERNANDO CHAZAN
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MARCELE BOCATER PAULO DE PAIVA
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MIGUEL ANGELO MONTAGNER
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PATRÍCIA SAMPAIO CHUEIRI
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XIMENA PAMELA CLAUDIA DIAZ BERMUDEZ
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Data: 04-oct-2023
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Resumen Espectáculo
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“Introduction: Despite extensive debates and scientific productions surrounding sexuality today, it still occupies a terrain of disputes crossed by various normative and hegemonic discourses, marked by the regulation of bodies – and consequently, expressions of sexuality – under the exercise of powers of political, economic, religious, legal, cultural, and moral orders. It is in this scenario that medicine, faced with the growing demand related to sexual issues in clinical practice, has been called upon to take a position on the communication and teaching of sexuality in the education of its professionals; a call that this research seeks to address by investigating, as a starting point, the perception of female and male teachers, preceptors, and residents in family and community medicine regarding the communication of sexuality in consultations within the scope of Primary Health Care. General Objective: To analyze clinical communication of sexuality, with a focus on women's sexuality, in its approach by professionals engaged in Family and Community Medicine Residency Programs within the Primary Health Care network of the Federal District (DF). Specific Objectives: To map and analyze cases and narratives about the approach to sexuality, relating them to the practice of clinical communication in consultations with women; to characterize the conceptions of family physicians regarding the approach to female sexuality; to identify challenges and strategies of healthcare professionals regarding clinical communication of sexuality in the context of the research. Method: This is a qualitative research conducted under the triangulation of analysis and data collection methods, including the comprehensive approach according to the hermeneutic-dialectic perspectives of Hans-Georg Gadamer and Jürgen Habermas, narrative interviews, and focus groups. The research participants are family and community medicine professionals linked to Family and Community Medicine Residency Programs in the DF from three institutions: Universidade de Brasília (UnB), Escola Superior de Ciências da Saúde (ESCS) e Fundação Oswaldo Cruz (Fiocruz). Data collection involved 04 focus groups and 09 interviews, totaling 50 participants. Results: Challenges and formative gaps in communication skills were identified, as well as insecurities and a sense of unpreparedness in the clinical care of physicians regarding the approach to female sexuality. The numerous barriers to clinical communication of sexuality identified and analyzed in the research were classified into categories: barriers related to patients; structural barriers of Primary Health Care services; technical and formative barriers; barriers related to the doctor-patient relationship; barriers related to the LGBTQIA+ population; barriers related to the elderly population; barriers related to the approach to violence; intercultural barriers; and barriers at the intersection of sexuality and religion. Conversely, a great interest in enhancing clinical communication in sexuality was observed among the participating professionals. Conclusion: Sexuality reveals itself as a prevalent demand in the everyday care of Primary Health Care and a central component of comprehensive health, but there is a significant gap between the proposals of the World Health Organization for its approach and the practices observed in medical clinics. The study suggests that identifying barriers to communication of sexuality in the context of Primary Health Care is an essential process for theoretical, practical, and pedagogical advancement in the field, allowing for the development and application of necessary resources to overcome them in medical education.”
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9
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ALANA DANTAS BARROS
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“Weaving senses: the contribution of speech therapy to voice and communication of trans and with various gender identities _”
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Líder : ANA VALERIA MACHADO MENDONCA
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MIEMBROS DE LA BANCA :
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ANA VALERIA MACHADO MENDONCA
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EDU TURTE CAVADINHA
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FLAVIA DO BONSUCESSO TEIXEIRA
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MARIA FATIMA DE SOUSA
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RODRIGO DORNELAS DO CARMO
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Data: 03-nov-2023
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Resumen Espectáculo
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“Introduction: Speech Therapy has been researching and increasingly acting with issues related to gender diversity, seeking most studies, understanding how the voice impacts the lives of trans people and how it can be worked from a perspective of adapting to characteristics of gender. Nevertheless, the imperativity of deep reflection and a critical review of research and intervention approaches in speech therapy in relation to gender diversity has been broadly highlighted. As well, concrete and grounded proposals have been outlined that point out clear directions, especially in relation to ethical posture and the theoretical-epistemological orientation adopted in the treatment of this topic. As for theoretical basis for this speech therapy practice, currently the perspective suggested as one of the most appropriate to understand voice and communication in relation to the speaker's sociocultural positioning is the biocultural perspective. From it, several factors act continuously and dynamically in the production of voice and communication, which differentiates it from the deterministic perspective, for example, which considers this production as exclusively dependent on biological and physical aspects. As it was established by the most current international recommendations, the purpose of professionals who provide gender affirmation assistance should be, first and foremost, to establish effective collaboration with different trans and gender identities. In order to fully address social, mental and medical needs, aiming mainly to promote well-being, while fully respecting their gender identities. These care guidelines also advocate the adoption of a person -centered service model, as well as reviewing several previous recommendations, all for the purpose of eliminating barriers that can make access to the necessary care difficult. Objective: This study aimed to analyze and reflect on the contribution of a group speech therapy approach to trans and with various gender identities, exploring their perceptions related to voice and communication. Methodology: It is a qualitative approach research, based on the methodological approach of dialectical hermeneutics, developed with trans and with various gender identities. Inclusion criteria were people over 18 who identified themselves as trans or with a diverse gender. No exclusion criteria related to gender identity were stipulated. The technique selected for data collection were group research workshops developed from the theoretical-methodological perspective of social constructionism applied to group practice. The proposed practices were based on concepts of vocal self -perception and vocal psychodynamics. Four workshops were held with the participation of 10 people. The meetings had an average duration of 100 minutes each, were recorded in audio and video and later transcribed for analysis. Transcripts underwent an analysis based on the techniques of the dialectic hermeneutic method. Results and Discussion: Each workshop was analyzed individually and later reorganized for the purposes of synthesis, seeking to point out diversity and multiplicity. During the analysis the dialectical hermeneutics was used, from which empirical analytical categories gradually emerged. These categories were subsequently compared to predefined analytical categories to identify interrelationships and connections. This work emphasizes the importance of considering stress faced by minorities, such as trans and with various gender identities, due to discrimination and prejudice in a predominantly cis generous and heteronormative society. It is noteworthy that a group speech therapy can play a key role in reducing this stress and increasing well-being, promoting self-esteem, assertive communication and coping skills. In addition to reinforcing the arguments that support the effectiveness of group therapy for these people, both in relation to voice and self -perception. We emphasize the importance that such interventions are sensitive to the social context and allow the authentic expression of the voice. In addition, the biocultural perspective is discussed as a theoretical basis that comprises the voice as influenced by sociocultural forces and we highlight how the interpretation of the speaker's sociocultural positioning can be based on vocal expression, subject to variations due to listener sociocultural experiences. Finally, the need for a critical analysis of research and intervention approaches in speech therapy related to gender diversity, aligning with recent expert recommendations is reinforced. Given the proper emphasis on the importance of ethics and the theoretical approach when addressing this topic. Conclusion: Recognize the semantic richness of a group, either through workshops or other formats based on solid theories, enables the exploitation of discourses from a perspective that values relational discursive practice to the detriment of individual analysis. This discursive approach is profoundly enriching in terms of meanings that can be explored in various directions, both in the research context and intervention, in the context of speech therapy, particularly regarding issues related to gender diversity. In this scenario, an integral health approach is a strategy that incorporates voice and communication as integral elements of a comprehensive model of care, while fostering the sharing of knowledge and skills. Meaning constructions and resignification processes assume a dialogical nature, playing a role of importance not only for the participants involved, but also for the group's facilitators. The social position occupied by researchers or therapists is revealed as a complex position, characterized by ethical and political dimensions, and influenced by various beliefs and sociocultural issues.
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10
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Camile Giaretta Sachetti
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ADVANCED THERAPY MEDICINAL PRODUCTS IN BRAZIL: CHALLENGES AND OPPORTUNITIES FROM RESEARCH TO ACCESS
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Líder : EVERTON NUNES DA SILVA
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MIEMBROS DE LA BANCA :
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Carlos Medicis Morel
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EVERTON NUNES DA SILVA
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LEONOR MARIA PACHECO SANTOS
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MARIA SUELI SOARES FELIPE
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MARTIN HERNAN BONAMINO
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Data: 15-dic-2023
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Resumen Espectáculo
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Introduction: Advanced Therapy Medicinal Products (ATMPs) are innovative biologics that holds the promise of revolutionizing treatments, particularly for rare diseases and unmet medical needs. However, they represent the most challenging category of new technologies, both due to their complex development and high prices, which impose specific regulatory demands. Therefore, promoting access has become a major challenge for governments and industries, especially in countries with universal and comprehensive health care. Goals: The first aim of this study was to analyze the evolution of Research and Development (R&D) investments made by the Ministry of Health (MoH) of Brazil and partners in the ATMPs. Second, it was identify the industry's experience in clinical development, marketing authorization and access to ATMPs through the Unified Health System (SUS, acronym in Portuguese), from a regulatory perspective. Methods: A descriptive analysis was performed based on secondary data to achieve the first aim. Additionally, a survey containing structured questions was conducted among research participants who work at companies that commercialize ATMPs, and a descriptive analysis was performed. Results: The investments coordinated by the MoH (61.5%) in partnership with S&T, education, and economy sectors (38.5%) consisted of Int$ 137.35 million in 282 ATMPs projects. Funding included scientific, technological, and innovation research (67% of the total amount) and projects to implement or maintain infrastructure in selected research centers (32.98%). On the global convergence, cell therapy was the ATMP that most benefited from public investment, especially basic and preclinical research. Cardiology and Neurology were the focus of clinical trials. The survey included 10 foreign pharmaceutical companies. Overall, participants assessed that Brazil has a well-established regulatory system, especially the sanitary registration by the National Health Surveillance Agency (Anvisa), which ensures the quality, safety, and efficacy of the products. The Agency's good interaction with the regulated sector, the harmonization of sanitary and ethical assessment systems with other countries, and the analysis time in the biosafety assessment of Genetically Modified Organisms (GMOs) stand out as positive in industry’s evaluation. On the other hand, it is important to advance the pricing regulation for these products since Brazilian regulations do not establish specific criteria for ATMP. Despite the need to implement improvements in the Brazilian investment policy of R&D of ATMPs, as well as to advance regulatory improvements (especially in pricing and HTA), Brazil has made important progress and can serve as a benchmark for other countries with socio-economic similarities. To provide the population with universal, equitable and sustainable access to ATMP in the SUS, it is recommended to promote continuous financing of R&D and create effective public policies to promote the national Health Economic-Industrial Complex, based on a mission-oriented that considers value for public health. Considering the increasing number of approvals of cell and gene therapies in Brazil in the coming years and the financial impact on the SUS, it is suggested to consider explicit priority-setting approaches to support HTA, as well implement encourages innovative models of financing, especially those that consider risk-sharing and co-financing between combinations of interested parties, such as public-public and/or public-private participation (Blended Finance).”
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